The two other elements were reeducation and discipline. Once suggestion had brought the patient to believe firmly that he would be cured, he was made to understand that his cure would be permanent.
Then reeducation was inst.i.tuted to overcome the bad habit of lack of confidence that had been formed, while discipline broke down the psychic resistance of the patient to the idea of recovery. In such symptoms as mutism or deafness, the patient was told that electricity would cure him and that as soon as he felt the current when the electrode was applied, his power of speech or of hearing would be restored, _pari pa.s.su_, with sensation. The same method was used for blindness and other sensory symptoms. Paralyses were favorably affected the same way, though tremors were harder to deal with. A cure in a single treatment was the best method, for the patient readily relapsed unless he was made to feel that he had recovered his powers completely and that it would be his own fault if he permitted his symptoms to recur.
The most interesting phase of the successful treatment of these war neuroses for us was {264} the fact that the ultimate dependence was placed by the French on a system of management which was called _torpillage_. _Torpillage_ consists in the brusque application of faradic currents strong enough to be extremely painful in hysterical conditions, and the continuance of the procedure to the point at which the deaf hear, the dumb speak, or those who believe themselves incapable of moving certain groups of muscles come to move them freely. The method has proved highly effective and requires but little time and practically no personnel except the medical officer who applies the treatment and the non-commissioned officer who takes the patient at the end of the treatment and continues the exercise of the afflicted parts. One treatment suffices. The apparatus is of the simplest, the only accessory to the electric supply and the electrodes consisting of an overhead trolley which carries the long connecting wires the whole length of the room, thus making it impossible for the patient to get away from the current which is destined to cure him.
In a word, the man who would insist on maintaining a false att.i.tude of mind towards himself, though that att.i.tude of mind was not {265} deliberate, and least of all not malingering, was simply made to give it up. Sufficient pain was inflicted on him so that he was willing to accept instead of his own false opinion the opinion of his physician that he could accomplish certain functions. _Torpillage_ was, in other words, simply "a method of treatment which gave authority to a medical officer to inflict pain on a patient up to the point at which the patient yields up his neurosis." As a rule, the infliction of very little suffering is needed, for once the demonstration is made that he will have to suffer or give in, it does not take him very long to give in. There is no doubt at all that the method is eminently effective, particularly in those cases which were entirely refractory to other modes of treatment.
It would remind us of some old modes of treatment which were in popular use long ago, but which had gone out entirely in our milder generation because we thought their use almost unjustified. It was not an unusual thing three or four generations ago to rouse a young woman out of an hysterical tantrum, once it was perfectly clear from previous experiences that it _was_ really an hysterical tantrum, by dashing a pitcher of cold water {266} over her. Sir Thomas More relates that he saw a number of people suffering from various forms of possession--and any neurologist will confess that some hysterics must have a devil--who were cured by being roundly whipped. Certain men and women who complained that they were unable to walk or to work and thus became a care for relatives or for the community, were cured by this, as it seemed to later generations, heartless mode of treatment.
Now, we have turned to curing the war hysterias by punishment, that is, by the infliction of severe pain, in just the same way. A great many of these patients who suffer from neuroses and psycho-neuroses, and especially from hysterical inhibitions so that they cannot hear or cannot walk or cannot talk, represent inabilities similar to many which are seen in civil life. Patients complain that they cannot do things; their friends say that they will not do them; and the physician sees that the root of the trouble is that they cannot _will_. Now, however, that war has permitted the use of such remedies, physicians have found that they can, to advantage, force the patients to will and that once the will has been recalled into action, its energy can be maintained.
{267}
Of course the compulsory mode of treatment was not represented as a punishment, but on the contrary it was always presented as a form of treatment which was extremely painful but necessary for the condition.
Presented as punishment, it would have been resented, and the patient would probably have set about sympathizing with himself and perhaps seek the sympathy of others, and this would prevent the effectiveness of the treatment. It is very evident that as the result of compulsory methods of treatment, and of the recognition of the fact that major hysterical conditions are largely the result of suggestion and must be cured by enabling the patient to secure control over himself again, the outlook for the treatment of the psychoneuroses will be very different as a consequence of the experience that has been gained.
Above all, the place of the will will be recognized, and there will no longer be that coddling of patients and that a.n.a.lysis of their minds for long distant psychic insults of various kinds which will explain their condition, that has done so much harm in a great many ways in recent years.
Another feature of the French treatment was that the neurotic patients should be {268} isolated. This isolation was complete. It had been found that a.s.sociation with other patients, the opportunity to tell their troubles and be sympathized with, did them harm invariably and inevitably, so that those whose neurotic symptoms continued were taken absolutely away from all a.s.sociation with others. Not only this, but all other modes of diversion of mind were denied them. They were placed in rooms without reading or writing materials and even without tobacco. This solitary confinement would remind one of the enforced privacy of the old-fashioned rest cure in which the patient was absolutely secluded from all a.s.sociation with relatives or others who might in any way sympathize with them. The soldier patients were kept in this complete isolation until such time as they showed themselves amenable to treatment. This was usually not very long.
As a matter of fact, the isolation rooms had to be used very little but were found necessary and especially effective in the management of relapsed cases. Just as soon as soldier patients learned that such isolating rooms were available, they became much more ready to give up their neuroses, and as a consequence, in most places, the isolating department did {269} not have to be used, and in some places they could even be given over to the lodgment of attendants. It was quite sufficient, however, that they had fulfilled their purpose of changing patients" att.i.tude of mind towards themselves and giving their will control over them.
As Colonel Pearce Bailey, M.C., says, in most of these patients, persuasive measures and contrary suggestion were quite sufficient, but when they failed, disciplinary measures proved effective. How are we going to be able to make such disciplinary measures available in civil life is another question, but at least the war has made clear that neurotic patients who claim that they cannot do something and actually will not do it, _must be made to do it_, for this will prove the beginning of their cure. It seems probable, as Doctor Bailey adds, that the reason why the treatment of officers was more difficult--and it must not be forgotten that in proportion to their numbers, four times as many officers suffered from so-called sh.e.l.l shock as privates--was exactly because these modes of discipline, amounting practically to compulsion, were not used with them.
{270}
CHAPTER XIX
FEMININE ILLS AND THE WILL
"Oh, undistinguished s.p.a.ce of woman"s will!"
_King Lear_.
It is probable that the largest field for the employment of the will for the cure of conditions that are a source of serious discomfort or at least of complaint is to be found among the special ills of womankind. The reason for this is that the personal reaction has so much to do with the amount of complaint in these affections. Not infrequently the individual is ever so much more important than the condition from which she is suffering. Women who have regular occupation with plenty to do, especially if they are interested in it and take their duties seriously, who get sufficient exercise and are out of doors several hours each day and whose appet.i.tes are as a consequence reasonably good, suffer very little from feminine ills, as a rule. If an infection of some kind attacks them, they will, of {271} course, have the usual reaction to it, and this may involve a good deal of pain and even eventually require operation. Apart from this, however, there is an immense number of feminine ills dependent almost entirely on the exaggerated tendency to react to even minor discomforts which characterizes women who have no occupation in which they are really interested, who have very little to do, almost no exercise, and whose appet.i.te and sleep as a consequence are almost inevitably disturbed.
Above all, it must not be forgotten that whenever women do not get out into the air regularly every day--and this means for a time both morning and afternoon--they are likely to become extremely sensitive to pains and aches. This is true of all human beings. Those who are much in the open air complain very little of injuries and bodily conditions that would seem extremely painful to those living sedentary lives and who are much indoors. Riding in the open air is better than not being in the open air at all, but it does not compare in its power to desensitize people with active exercise in the open air. In the older days, when women occupied themselves very much indoors with {272} sewing, knitting and other feminine work, and with reading in the evenings, and when it was considered quite undignified for them to take part in sports, neurotic conditions were even more common than they are at the present time, and young women were supposed to faint readily and were quite expected to have attacks of the "vapors" and the "tantrums."
The interest of young women in sports in recent years and the practice of walking has done a great deal to make them ever so much healthier and has had not a little to do with decreasing the number and intensity of the so-called feminine ills, the special "women"s diseases" of the patent medicine advertis.e.m.e.nts. Much remains to be done in this regard, however, and there are still a great many young women who need to be encouraged to take more exercise in the open than they do and thus to live more natural lives. It is particularly, however, the women of middle age, around forty and beyond it, who need to be encouraged to use their wills for the establishment of habits of regular exercise in the open air as well as the creation of interests of one kind or another that will keep them from thinking too much about {273} themselves and dwelling on their discomforts. These are thus exaggerated until often a woman who has only some of the feelings that are almost normally connected with physiological processes persuades herself that she is the victim of a malady or maladies that make her a pitiable object, deserving of the sympathy of her friends.
A great many of the operations that have been performed on women during the past generation have been quite unnecessary, but have been performed because women felt themselves so miserable that they kept insisting that something must be done to relieve them, until finally it was felt that an operation might do them some good. It would surely do them no harm or at least make them no worse, and there was always the possibility that the rest in the hospital, the firm persuasion that the operation was to do them good, the inculcation of proper habits of eating during convalescence might produce such an effect on their minds as would give them a fresh start in life. Undoubtedly a great many women who were distinctly improved after operations owed their improvement much more to the quiet seclusion of their hospital life, their own strong expectancy {274} and the care bestowed upon them under the hospital discipline without exaggerated sympathy which brought about the formation of good habits of life, than to their operation. Many a woman gained weight after an operation simply because her eating was properly directed, and this was the main part of the improvement which took place.
Operations are sometimes needed and when they are the patient will probably not get well without one; but as a distinguished neurologist, Doctor Derc.u.m of Philadelphia, said in a paper read before the American Medical a.s.sociation last year, the neurologist is constantly finding patients on whom one or several operations have been performed, some of them rather serious abdominal operations, the source of whose complaints is a neurosis and not any morbid condition of the female or other organs. Occasionally one sees something like this in men, and I shall never forget seeing at Professor Koenig"s clinic in Berlin a sufferer from an abdominal neurotic condition on whom no less than three operations for the removal of his appendix had been performed, until finally Professor Koenig felt that he would be justified in tattooing over the right iliac region the words "No Appendix {275} Here." The condition developed in a young soldier as the result of a fall from a horse and his affection resembled very much some of the neuroses that came to be called, unfortunately, "sh.e.l.l shock" during the present war.
The princ.i.p.al trouble in securing such occupation of mind as will prevent exaggerated neurotic reactions to even slight discomforts in women is the creation for them of definite interests in life. The war taught a notable lesson in this regard. Many a physician saw patients whose complaints had been a great source of annoyance to them--and their friends--proceed to get ever so much better as the result of war interests. In one women"s prison in an Eastern State, just before the war, a series of crises of major hysteria was proving almost unmanageable. By psychic contagion it had spread among the prisoners until scarcely a day pa.s.sed without some prisoner "throwing a fit"
with screaming and tearing of clothes and breaking of articles that might be near. Prominent neurologists had been consulted and could suggest nothing. When the war began, the prisoners were set to rolling bandages, knitting socks and sweaters and making United States flags for the army. As if by magic, the neurotic {276} crises disappeared.
For months there were none of them. The prisoners had an abiding interest that occupied them deeply in other things besides themselves.
The reduction of nervous complaints of various kinds among better-to-do women was very striking. As might be expected, their rather strenuous occupation with war activities kept them from thinking about themselves, though it is true that now they complain about all the details that they had to care for and the lack of cooperation on the part of certain people. It would seem as though many of them had so much to do that they would surely exhaust their energies and so be in worse condition than before, but this very seldom proved to be the case. Literally many thousands of women improved in health because they became interested in other people"s troubles instead of their own. David Harum once said that "It is a mighty good thing for a dog to have fleas because it keeps him from thinking too much about the fact that he is a dog." That seems a rather unsympathetic way of putting the case, but there is no doubt at all that what many women need is serious interests apart from themselves in order to prevent the law of {277} avalanche from making minor ills appear serious troubles.
What most women need above all are heart interests rather than intellectual occupations. That was why occupation with war activities did so much good. That is the reason, too, that club life and reading and other similar pursuits often fail to be helpful to women in their ills to the extent that might possibly be expected. Above all, women need interests in children and the ailing, and these can be supplied by visits to hospitals or by taking an active interest in nurseries, though this is often not personal enough in its appeal to catch a woman"s deepest attention. One of the great reasons why there are more nervous diseases among women in our time than in the past is because children are fewer, and because so many women are without children and the calls that they inevitably make on their mothers. Unfortunately, the traditions of the present day are to a great extent in opposition to that family life with a number of children, which means not only the deepest interests for woman but also such inevitable occupations in the care of them that she has very little time to think about herself. It may seem quixotic, that is, {278} demanding unnecessary magnanimity to suggest that these modern ideas should be discarded by those who wish to a.s.sure themselves such interests in middle life as will prove definitely preventive of many neurotic conditions, but it is manifestly the physician"s duty to make such suggestions.
Life has really become full of dreads for many women in this regard. A gradual reduction in the birth rate which has deprived so many women of the heart interests that were particularly valuable at and after middle life; has been the source of a great deal more suffering without any satisfaction, than would be a.s.sociated in any way with the care of children. It is extremely unfortunate, then, that this phase of social evolution should have taken place, for the quest of ease and pleasure has proved a prolific source of feminine ills. It is well recognized now that the reason for this reduction in the birth rate is not physical but ethical. It is a matter of choice and not necessity.
There is a conscious limitation of the number of children in the family accomplished deliberately, and as a rule the women consider that they are justified in the procedure because they thus conserve their own health and provide such {279} few children as they have with healthier bodies than would otherwise have been the case.
Indeed, child-bearing beyond one or two or perhaps three children has become a source of dread in modern times, a dread that supposedly centers around the health of the children, as well as the mother herself. The mother of a few children is supposed to be healthier and the children of small families to be heartier and more vigorous than when there are half a dozen or more children in the family. A woman is actually supposed by many to seriously imperil her life and her health if she has more than two or three children, though as a matter of fact, the history of the older times when families were larger shows us that women were then healthier on the average than they are now, in spite of all the progress that medicine and surgery have since made in relieving serious ills. Above all, it was often the mother of numerous children who lived long and in good health to be a blessing to those around her, and not the old maids nor the childless wives, for longevity is not a special trait of these latter cla.s.ses of women. The modern dread of deterioration of vitality as the result of frequent child-bearing is quite without {280} foundation in the realities of human experience.
Some rather carefully made statistics demonstrate that the old tradition in the matter is not merely an impression but a veritable truth as to human nature"s reaction to a great natural call. While the mothers of large families born in the slums with all the handicaps of poverty as well as hard work against them, die on the average much younger than the generality of women in the population, careful study of the admirable vital statistics of New South Wales show that the mothers who lived longest were those who under reasonably good conditions bore from five to seven children. Here in America, a study of more favored families shows that the healthiest children come from the large families, and it is in the small families particularly that the delicate, neurotic and generally weakly children are found.
Alexander Graham Bell, in his investigation of the Hyde family here in America, discovered that it was in the families of ten or more children that the greatest longevity occurred. So far from mothers being exhausted by the number of children that were born, and thus endowing their children with less vitality than if they {281} had fewer children, it was to the numerous offspring that the highest vitality and physical fitness were given. One special consequence of these is longevity.
In a word, the dread so commonly fostered that the mothers of large families will weaken themselves in the process of child-bearing and unfortunately pa.s.s on to their offspring weakling natures by the very fact that they have to repeat the process of giving life and nourishment to them at comparatively short intervals, is as groundless as other dreads, for exactly the opposite is true. It is when nature is called upon to exert her amplest power that she responds most bountifully and dowers both children and mother with better health in return.
Something of the same thing is true with regard to the age of mothers when their children are born. The infant mortality is lowest among the children of young mothers between twenty and twenty-five years of age, though it has been found out that "delay in child-bearing after that age penalizes the children." This is, of course, true particularly for first children. The successive children of young mothers are known by observation and statistics as being constantly in {282} better condition up to the seventh. There is on the average nearly a half a pound difference in weight at birth between succeeding children of the same mother, so that each infant is born st.u.r.dier and more vigorous than its predecessor.
These recently collated facts remove entirely the supposed foundations of a series of dreads which were having an unfortunate effect upon our population, for the natives were disappearing before the foreigners because of the higher birth rate among the latter. Birth control has been producing a set of unfortunate conditions for both mothers and children. The one child in the family is sure to be spoiled, not only as a social being but often as regards health, and conditions are scarcely better when there are but two, especially if they are of opposite s.e.xes. If anything happens to them, the mother has nothing to live for, and a little later in life the selfish beings that have been raised under the self-centered conditions of a small family are almost sure to be a source of anxiety and worry. Many a woman owes the valetudinarianism of her later years to the fact that she dreaded maternal obligations and avoided them, and so the latter part of her life is {283} empty of most of what makes life worth living.
The will to make life useful for others rather than to follow a selfish, comfortable, easy existence is the secret of health and happiness for a great many women who are almost invalids or at least constantly complaining in the midst of idle lives. A woman who has nothing better to occupy her time than the care of a dog or two cannot expect to have any interests deep enough to divert her attention from the pains and aches of life that are more or less inevitable. The opportunity to dwell on them will heighten their intensity until they are almost torments. Many more of the feminine ills can be explained in this way than by learned pathological disquisitions. Every physician has seen the bitterest complaints disappear before some change of life that necessitated occupation and gave the patient other things to think about besides self.
The will to face nature"s obligations of maternity straightforwardly is probably the greatest preventive against the psycho-neuroses that prove so seriously disturbing to a great many women. Their affections, given a proper opportunity to develop, impel their {284} wills to such activity as prevents the development of morbid states. The dreads for themselves and their children, which so often make the excuse for a different policy in life than this, have proved unfounded on more careful study. Now that war activities no longer call women, it must not be forgotten that home duties are the only ones that can serve as a universal antidote for the poison of self-indulgence, which is much more productive of symptoms of disease than the autointoxications of which we have heard so much, but for which there is so little justification in our advancing science. The a.s.sumption of serious duties is the best possible panacea for the ills of mankind as well as womankind, only unfortunately in recent years women have succeeded in shirking duties more and have paid the inevitable price which nature always demands under such circ.u.mstances, when the dissatisfaction in life is much harder to bear than the work and trials involved in the pursuit of duty.